Projected cost-effectiveness of repeat high-risk human papillomavirus testing using self-collected vaginal samples in the Swedish cervical cancer screening program

Acta Obstet Gynecol Scand. 2013 Jul;92(7):830-40. doi: 10.1111/aogs.12143. Epub 2013 Apr 22.


Background: Human papillomavirus (HPV) testing is not currently used in primary cervical cancer screening in Sweden, and corresponding cost-effectiveness is unclear.

Objective: From a societal perspective, to evaluate the cost-effectiveness of high-risk (HR)-HPV testing using self-collected vaginal samples.

Design: A cost-effectiveness analysis.

Setting: The Swedish organized cervical cancer screening program.

Methods: We constructed a model to simulate the natural history of cervical cancer using Swedish data on cervical cancer risk. For the base-case analysis we evaluated two screening strategies with different screening intervals: (i) cytology screening throughout the woman's lifetime (i.e. "conventional cytology strategy") and (ii) conventional cytology screening until age 35 years, followed by HR-HPV testing using self-collected vaginal samples in women aged ≥35 years (i.e. "combination strategy"). Sensitivity analyses were performed, varying model parameters over a significant range of values to identify cost-effective screening strategies.

Main outcome measures: Average lifetime cost, discounted and undiscounted life-years gained, reduction in cervical cancer risk, incremental cost-effectiveness ratios with and without the cost of added life-years.

Results: Depending on screening interval, the incremental cost-effectiveness ratios for the combination strategy ranged from €43,000 to €180,000 per life-years gained without the cost of added life-years, and from €74,000 to €206,000 with costs of added life-years included.

Conclusion: The combination strategy with a 5-year screening interval is potentially cost-effective compared with no screening, and with current screening practice when using a threshold value of €80,000 per life-years gained.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Computer Simulation
  • Cost-Benefit Analysis
  • DNA, Viral
  • Early Detection of Cancer / economics*
  • Early Detection of Cancer / methods
  • Female
  • Health Care Costs
  • Human Papillomavirus DNA Tests / economics*
  • Humans
  • Markov Chains
  • Middle Aged
  • Models, Biological
  • Papillomavirus Infections / complications
  • Papillomavirus Infections / diagnosis*
  • Papillomavirus Infections / economics
  • Risk
  • Sweden
  • Uterine Cervical Dysplasia / diagnosis
  • Uterine Cervical Dysplasia / economics
  • Uterine Cervical Dysplasia / prevention & control*
  • Uterine Cervical Dysplasia / virology
  • Uterine Cervical Neoplasms / economics
  • Uterine Cervical Neoplasms / prevention & control*
  • Uterine Cervical Neoplasms / virology
  • Vaginal Smears / economics*
  • Vaginal Smears / methods
  • Young Adult


  • DNA, Viral